I just can’t say it enough – if you grind your teeth, you need a properly made and professionally adjusted nightguard!
Perfect situation this morning: a young lady of only 29 years age came in for a root canal and crown on a lower molar because of a badly cracked tooth. It didn’t look all that bad on the outside, and seeing how small the previous filling was, you’d really think that the chances of this are practically non-existent……..but you’d be wrong. Take a look:
And let me tell you – it is NOT a coincidence that this young lady has suffered from chronic migraines for years, but we haven’t addressed that for her quite yet. First we had to get her out of the terrible pain she had every time she bit down.
If you grind or clench your teeth (and notice that this tooth doesn’t even look worn down or flattened), please be willing to spend a little money, even if your insurance doesn’t cover it. It could literally save you THOUSANDS of dollars in dental treatment, lots of time in the dentist’s chair, and even pain.
While silver/amalgam fillings are not requested very often in our practice, as most prefer to have fillings that blend in with their natural teeth, they are something that we do when situations warrant, as I discussed in an earlier post.
However, when it comes to the general topic of silver fillings, there are a lot of misconceptions, myths, and outright falsehoods out there. There are groups that CLAIM to have proof of a vast conspiracy by dentists to poison our population by using silver fillings (these are probably the same groups who believe that fluoride is a Russion attempt at mind-control of US citizens so they can take us over – hasn’t happened yet, and the conspiracy has been around for decades.); these groups CLAIM to have scientific proof that the mercury in silver fillings is poison that will lead to an absolutely amazing range of diseases, and that the simple removal of those amalgam fillings will almost magically cure those diseases. And it gets even wilder than that, but unless you’re specifically looking for a good laugh at how crazy these conspiracy theories get, I won’t bore you with all of them.
Let me be perfectly clear about my stance on this issue:
To date, there is absolutely NO, repeat NO CREDIBLE EVIDENCE that the small amounts of mercury present in amalgam/silver fillings causes any disease or disorder whatsoever.
I hope that was clear enough. 🙂
If silver fillings were as bad as the conspiracy theorists claim, then pretty much the whole world would be crazy, as amalgam fillings have been placed by the billions over the last 100+ years. My parents, for example, would have been beset by a myriad of illnesses, as both of them had a mouthful of silver fillings for many decades, and only recently have they been replaced as they’ve slowly worn out. Any strange illnesses in either of them? Nope. Nothing changed after they were taken out 1-by-1 either.
As a rather interesting side note: during my dental school years at the University of North Carolina at Chapel Hill School of Dentistry, I did a 2-month summer exchange at the dental school in Munich, Germany. While there, I was approached by several professors to proof-read some studies that they had translated prior to publishing them in English-language dental journals. Please bear in mind that Germany has pretty much banned amalgam fillings for many years, so it’s not like they are fans of the material. These professors had carried out a study that attempted to find a link between the presence of amalgam filings and a wide range of diseases and disorders; the study had lasted 5-6 years. And what were the results? Simply this:
They were unable to find any positive evidence of a connection between the amalgam fillings and ANY of the list of diseases and disorders that they had listed. Not one.
Kind of interesting coming from professors in a country that has practically banned the material for as long as they have, don’t you think?
As I’ve mentioned, there are 2 basic “philosophies” of dental care, although I didn’t really spell them out. They are (approximately, please understand!):
1) Watch and wait until it it actually hurts or breaks,
2) Diagnose and recommend treatment BEFORE it actually hurts or breaks.
As a general rule, at Smiles by Payet Dentistry, we follow the second philosophy. The key to remember, though, is that it is ALWAYS up to YOU to decide when to actually proceed with treatment. I’ll show you what I see by digital photography and x-rays, give you my recommendations, and then it’s up to you to decide what to do about them. We understand that the treatment has to fit into your life – your budget, your schedule, your priorities. I give you my word — I will NEVER pressure you into doing any treatment. I MAY make some very strong recommendations and urge you to proceed with treatment so that you avoid pain, loss of teeth, or other complication, but it’s still your decision, and we promise to respect that.
One of the tricky parts of dentistry is this: we can’t see through old fillings and crowns and bridges, not even with digital x-rays, digital photography, not even with the Zeiss PICO dental microscope that I use. We can only see things AROUND them. And quite honestly, as much as I believe silver amalgam fillings are a perfectly acceptable treatment, I also believe that they hide a multitude of evils. I already showed you the cracks that are often associated with big, old silver fillings, especially in patients who grind their teeth. What I didn’t show you, though, is how much decay (cavity) can be hidden from us by old silver fillings. They may not hurt, but it is not uncommon for there to be so much decay under them that a root canal becomes necessary when it’s all removed — and often times it can not be seen on x-rays! This makes it frustrating for patients, can’t understand why we recommend replacing a filling with a new filling or a crown.
So along with examples of the beautiful dentistry that we provide, I’ll also regularly show you the problems we often encounter when treating teeth, which should help you, the patient, better understand the WHYs of our recommendations.
A perfect example: This lady had these fillings for many years, probably over 20. The molar had just recently started bothering her a little with sensitivity to cold and sweets, but nothing serious. The main reason she wanted them replaced was for appearance, though — the greyish color really showed through on the front of the teeth. You’ll see that they don’t actually look all that bad to an untrained eye. After seeing thousands and thousands of them, though, I had some idea of what to expect……..but even I didn’t expect the problem to be so extensive.
Oh YUCK! See all that black crud? That’s decay — mushy, soft, and definitely NOT healthy. And this is fairly normal to find under 20+ year old fillings, to tell the truth.
Just some food for thought: maybe your dentist has recommended some treatment, perhaps to replace those silver fillings that have been there for 20-30 years, and maybe they’re not even bothering you, so you think, “Nah, I’ll just wait, doc. Thanks but no thanks right now.” Consider this: another 6 months, and this lady probably would have needed at least 1 root canal, maybe even 2. Not only would that have required more time, possible a lot of discomfort, but probably would have added another $1500-2000 in treatment costs.
Do you really want to wait?
In today’s world, when dental patients are increasingly savvy about dental care, but also increasingly worried that they’re being taken advantage of, developing the critical trust between a patient and our team is occasionally difficult. This is where the power of digital photography is so evident, and why I recently wrote about it on my photography blog (http://cdpayetphotography.wordpress.com), because communication is so much easier, and trust is so much easier to establish when you – the patient – see everything that we see. That’s one of the reasons that we document our work so extensively with Canon Digital Rebel XTi’s. Of course, the other reason we do is because we are proud of our work and love to show off what we can do to serve you and help you keep your teeth for your life. 🙂
Yesterday was a perfect example (although this patient has been with us for some time and we’ve already established that trust, plus she was having some pain). This old silver filling had provided many years of use for Mrs. X, but she was having off-and-on soreness and throbbing and wanted it looked at. When we took the picture and showed her the tooth, it was easy for her to understand why it was bothering her, as well as why we recommended a crown to save it; a root canal may well be needed, too, but we’re keeping our fingers crossed for her that she won’t.
Remember my last post about cracked teeth? Take a look at this tooth — SEVEN CRACKS! No wonder it was hurting. It’s almost a miracle that the tooth had not split in 1/2, to be honest.
And this is how the tooth looked after we’d shaped it for a crown (which we’ll make with our CEREC CAD/CAM system); the crack extends well below the gum line and very deep into the tooth from both sides.
If you ever have questions about the treatment that’s being recommended — ask to see pictures. X-rays are often very inadequate in diagnosing these problems. The cracks that are so evident here do NOT show up on x-rays; they’re too small.
Digital dental photography — the PATIENT’S friend.
One of the most common reasons that patients come to us for dental emergencies is cracked and broken teeth. For some reason, this always seems to happen on weekends, when you’re out at dinner, or right after we’ve closed for a long weekend – go figure. This is avoidable, though, if you act preventively. Here’s the key, though, and this is one of the reasons we use digital photography so extensively to communicate with our patients — very often these teeth won’t hurt at all until they break. Don’t ask me why – noone really knows. But so often, what we’ll here is, “Doctor Payet, it never bothered me at all, and then last night I was chewing on a banana and a big chunk of the tooth just broke off!”
Many doctors still go by the philosophy of, “If it ain’t broke and it don’t hurt, leave it alone.” The problem with that philosophy (in my humble opinion) is that when it finally does break, it will take more time, cost more money, and until it’s fixed is often pretty painful than if it had been treated before it broke. If it’s a small crack, treat it with a nightguard and a filling. If it’s a big crack, treat it with a nightguard and a crown. But if it breaks, you might well need a nightguard, root canal, build-up filling, and a crown. And all because the small crack wasn’t treated with a filling.
Research tells us that teeth with tooth-colored (composite resin) fillings crack just as often as those with silver fillings. My experience over 10 years, however, tells me that teeth with LARGE silver fillings crack much more frequently than with composite fillings. But even the bonding process can’t stop a crack from forming if the stress isn’t relieved. I’d like to show you some examples of what we often see:
It does seem that these cracks form around old fillings most of the time……..but they can even happen in teeth that have never had any work done. All it takes is a lot of force (usually grinding and/or clenching your teeth) and enough time. Here’s an example from a young man in his late 30’s who clenches his teeth so hard that he split this back molar completely in 1/2. It had NEVER had any dental work, and in fact, it didn’t even have a cavity. But he split it so far that it had to be extracted. Obviously I recommended a nightguard to help him not do this to any other teeth!
So what’s my point? Simply this: if you have been told that your tooth is cracked, at the VERY least, please make sure that you have a nightguard, because clenching and grinding of your teeth is the most common cause. But also — get it treated BEFORE it breaks. It’s less expensive and a lot less uncomfortable that way. And you won’t have to worry about it breaking over that long weekend or holiday when we’re out of the office.
For many years, the dental profession has been moving away from gold and silver restorations to composite (plastic) and porcelain/ceramic restorations. However, they are not always the smartest options for certain circumstances. While there is a lot of misinformation out there about the alleged dangers of (mercury) silver fillings, here’s the simple truth: Silver fillings are perfectly safe, and there is not ANY reputable research by any reputable organization that has shown that the mercury from the fillings causes ANY harm. PERIOD. All that misinformation is simply that – misinformation. ‘Nuff said.
When do I recommend silver fillings? There are just a couple circumstances in which I actually recommend silver fillings instead of a tooth-colored restoration (composite or porcelain):
1) Patients who have high rates of decay; IOW – anyone who seems to get cavities frequently no matter how hard they try to care for their teeth. These include patients with acid reflux, who drink a lot of sodas, who are on medications that dry up their saliva, who have recently been through radiation treatment of the head/neck, or similar conditions. In my experience, while there are steps that can be taken to reduce that risk, silver fillings last longer with fewer problems.
2) Patients who grind their teeth and who do not wear a nightguard. Again, in my experience and in a fair amount of current research, composite fillings do not last as long. While the ability of composite fillings to withstand significant wearing forces is definitely improving, in the teeth of patients who really grind, they’re just not there yet.
3) Patients who need a lot of work and need to stage it over time: in our practice, silver fillings are still less expensive because the material is less expensive. We still take just as much time as necessary to restore the tooth as with a composite filling, but we believe it is fair to pass on the savings in cost to our patients, because that helps make dentistry more affordable.
And the thing is, while old silver fillings can look pretty ugly and flat, properly-placed new silver fillings can look extremely natural, just not tooth-colored.
Here’s an example of a silver filling that’s probably been in place 20+ years:
Here’s what 2 shiny new amalgams can look like:
So while most patients still prefer tooth-colored restorations, there really isn’t anything wrong with silver fillings, and under some circumstances, they can be a better solution for some patients.